Alvarez L A, Resnick T J, Duchowny M S, Jayakar P
Departamento de Neurología, Miami Children's Hospital, Florida 33115-4079, USA.
Rev Neurol. 1996 Nov;24(135):1441-5.
The recent advances in the surgical treatment of epilepsy have resulted in great improvement in the overall outcome of these patients. The pediatric group has probably benefited the most as patients who previously were not candidate for this form of treatment are now able to undergo epilepsy surgery with results which are as good as those of adults. In fact, children may now benefit the most, as the control of their epilepsy and our ability to stop their anticonvulsants may allow them to better develop from a psychosocial aspect. Also, because of their plasticity, young children may tolerate surgery involving loss of eloquent cortex without subsequent permanent deficits. The most recent reported results from different centers indicate that 68-90% of patients undergoing temporal lobectomy remain seizure free while the percentage of patients remaining seizure free after extratemporal resections is approximately 50-66%. However, one of the problems with these results is that they vary significantly from one center to another because of the methodology used to evaluate results and the selection of patients depending on the strength of the centers. At present we do not have an optimal method to evaluate results of epilepsy surgery that takes in consideration not only seizure control but also psychosocial outcome. It is our goal to develop such method which will ultimately help us identify the best surgical candidates and predict their outcome.
癫痫外科治疗的最新进展已使这些患者的总体预后有了很大改善。小儿群体可能受益最大,因为以前不适合这种治疗方式的患者现在能够接受癫痫手术,其效果与成人一样好。事实上,儿童现在可能受益最大,因为控制他们的癫痫以及我们停用抗惊厥药物的能力可能使他们在心理社会方面得到更好的发展。此外,由于幼儿具有可塑性,他们可能耐受涉及切除明确功能皮层的手术而不出现后续永久性缺陷。不同中心最近报告的结果表明,接受颞叶切除术的患者中有68% - 90%不再发作,而颞叶外切除术后不再发作的患者比例约为50% - 66%。然而,这些结果存在的一个问题是,由于评估结果所采用的方法以及根据各中心实力对患者的选择不同,各中心之间差异很大。目前我们没有一种不仅考虑癫痫控制而且考虑心理社会预后的评估癫痫手术结果的最佳方法。我们的目标是开发这样一种方法,这最终将帮助我们确定最佳手术候选者并预测他们的预后。